Madelia Community Hospital

Resolutely Independent

Madelia Community Hospital creates its own niche in a diverse community and employs 100.

Photo by Jeff Silker

There have been offers—several in fact, including offers from big companies with big budgets. And although each offer has been seriously contemplated by the board of directors, the Madelia Community Hospital has resolutely remained independent.

“This community wants to keep its hospital independent,” says Candace Fenske, who has been the administrator of the hospital since 1992. “This is a rural area, and I think we have more of an independent spirit here.”

That independent spirit has kept Madelia Community Hospital (MCH) alive for the better part of a century. While other small-town healthcare facilities have accepted affiliations with larger organizations, MCH has survived, and in fact thrived on its own.

Today, the 25-bed nonprofit hospital employs almost 100; it has four active staff doctors and more than 20 other specialty doctors who have privileges there. (See page 33). It delivers an average of 40 babies per year, treats an average of 1,400 emergency room patients, and offers dozens of inpatient and outpatient surgical treatments—the most common, colonoscopies—to area residents. It provides physical therapy services, offers home healthcare, and through a partnership with Immanuel St. Joseph’s has hospice facilities.

“There’s no difference in the quality of care because we’re independent,” says Fenske, a Madelia native who started working at the hospital as a nurse 30 years ago.

During her tenure, many of the other small, urban hospitals in the region have embraced the name recognition and financial support of such hospital organizations as Mayo Health System and Allina Hospitals and Clinics. She understands why they choose to do so, but she also understands why MCH and a few others in the region (including Sleepy Eye and St. James) choose not to.

“We all want to provide high quality, safe medical care to our community,” she says. “We’re all here to provide for our patients.”

In 1917, Madelia’s first hospital, owned and operated by a local physician, took up residence in a stately Victorian house on Drew Avenue. In 1953, a new, larger facility was built just down the street, with room for 21 beds and enough space for general surgical procedures. That facility still stands as the Madelia Community Hospital today, although it has been stretched in nearly every direction in the 50-plus years since.

In the 1960s, the hospital added a lab. In the 1970s, its X-ray department was expanded. In 1992, the operating room was given more space. Two years later, a senior residence was added at the south end of the building. Between 1997 and 2000, the hospital added space for an adjacent clinic (which is operated by Mayo Health System), an ambulance garage, and a parking lot. In 2003, the physical therapy department moved out of a small room alongside the patient rooms into a sprawling, 5,000 square-foot space in the hospital’s basement. Last spring, construction of a post-anesthesia recovery and observation room was completed. The next project, Fenske says, will be replacing the original boiler with a new, more efficient model.

“It’s an old hospital,” she says, “but we do our best to keep it up.”

All the rooms, which occupy one long corridor, have been modestly but modernly decorated; wildlife art brightens the hallway. The postpartum room for new mothers is warm and cheery, complete with a walnut cradle crafted by the hospital’s own Dr. James Eiselt, who used wood from the former administrator’s land. The hospice room has been lovingly decorated by volunteers to be as homey and comfortable as possible, with quilts, country-style borders and decorations to distinguish the room—No. 15—from others along the way.

But keeping up means a lot more to Fenske than just decorating. More important to her, and to the hospital, is incorporating the latest medical technology wherever and whenever possible. That’s why the hospital purchased a CT scanner five years ago. Although not every small, community hospital can absorb the expense of such a machine, MCH decided the purchase was possible and went ahead. “It was important for us to have one,” Fenske says. “More and more, CT is becoming the diagnostic mode of choice. And it’s been a good decision for us—we average about 25 scans a month.”

Of course, the lifespan of a CT scanner is less than 10 years, which means the hospital’s “new” machine will need to be replaced in the near future. “We already know that this will have to be updated in the next three years,” Fenske says. “We’ll need a whole new machine then, because the technology has just changed that fast. But it’s already in the plans, so we’ll be able to do it.”

Such purchases are possible partly because the hospital plans well. But the private, nonprofit hospital has also benefited from the generosity of the community it serves. “This community has always been excellent to us,” Fenske says. “The community really supports us with donations.”

The hospital recently started its own foundation to accommodate the many gifts it receives. “We wanted a place for people who want to leave their legacy to the hospital,” she adds. “We can use those funds for equipment needs, for education for our employees, and to encourage young people who want to go into health care.”

The hope is that some of those young people might eventually find their way back to Madelia. Although recruiting and retaining physicians has never been a problem for the hospital, Fenske knows that it takes a special kind of doctor to put down roots in such a rural area. She also knows that the Madelia Community Hospital has been lucky so far.

Dr. Eiselt, who was honored as Physician of the Year by the Minnesota Academy of Family Physicians, has been part of the staff since 1971. The newer doctors—Dr. Jeffrey Kotulski, an independent physician who started serving the hospital in 1994, Dr. Jennifer Langbehn, who joined the staff in 1998, and Dr. Gustavo Colmenares, who came on board in 2003—seem happy to be part of both the hospital and the community.

“Once they get here, they seem to want to stay,” Fenske says. “We do try hard to look at profiles, to make sure that they want to be in a rural area. We want it to be a fit for both of us.”

Madelia is about a 30-minute drive from both Mankato and New Ulm—both of which have larger, more expansive hospitals than the Madelia Community Hospital. Mankato’s Immanuel St. Joseph’s, part of the Mayo Health System, is a 272-bed facility. The New Ulm Medical Center, affiliated with Allina Hospitals and Clinics, has 47 beds. Both have more medical staff and more service options.

But Fenske has no reason to feel as if her hospital is in competition with those other facilities. The relationship, she says, is more symbiotic than competitive. ISJ can take care of patients that MCH can’t serve safely, she says. “I like to think that we complement each other,” Fenske says. “We can provide different care for different populations. ISJ, for example, is a more acute-care hospital. The severity index is higher there.”

There are certainly cases that MCH isn’t equipped to handle—cardiac events, for example, and extensive surgeries. Bowel surgeries are likewise too complicated for the facility. In those cases, Fenske is glad to have specialized care nearby.

“We only lose patients to the larger hospitals when we can’t care for them safely,” Fenske says. “We know that what we need to do is to gear our offerings to the needs of this area’s population and to diversify our services as much as we can.”

The services available at MCH cover most of the procedures an aging community needs. More than 70 percent of the patients the hospital serves are on Medicare, Fenske says. If you need gallbladder surgery, you can schedule it at MCH. Ditto for hip replacements, arthroscopic procedures, colonoscopies and tonsillectomies. There’s a growing physical therapy department and a commitment to home health care as well.

“Home health care is available to anybody who wants it,” Fenske says. Currently, the home-health staff consists of three registered nurses, two licensed practical nurses, and three nursing assistants. Although they get to see new moms and babies at home, most of their visits are to elderly “clients.”

“The majority of what they do is alternative care for elderly people,” Fenske reports. “They provide the services that make it possible for those people to stay in their own homes. They make more than 9,000 visits each year to about 70 total clients.”

Those clients and the other patients served by the hospital are among the reasons the hospital continues to resist affiliating with a larger hospital organization. As long as the hospital can care for the community safely, it will likely do so on its own.

But Fenske knows the offers will continue to come. She knows that the hospital’s board will continue to consider them. She knows that the benefits, financial and otherwise, of aligning with a larger organization will be contemplated each and every time. But she knows that the community’s commitment to the hospital is unlikely to sway.

“This community wants to keep this hospital independent,” she reiterates. “For now, I think it will stay that way.”

One Stop Shopping

When entering Madelia Area Health Center, you have three choices: You can veer to the right and see a doctor at the clinic, you can head left and enter the hospital proper, or you can trot down a flight of stairs to have your teeth cleaned or your eyes examined.

Space in the lower level of the center is leased to Apple Tree Dental, a nonprofit dental organization that is committed to bringing dental care to people who might not otherwise get it, and to Madelia Optometric, Inc., a full-service vision clinic.

“The idea is that this can be one-stop shopping for all of your healthcare needs,” Fenske says.

Part of the hospital’s mission statement, in fact, is to “accommodate growth with all healthcare delivery systems in the Madelia area, including but not limited to the clinic, dentists, nursing homes, chiropractor, and optometry.”

Although each entity is separate and independent, Fenske says that all support each other whenever possible. The hospital and the dental clinic collaborated to go into local schools and put sealants on the teeth of first and fifth graders, for example.

“We collaborate,” Fenske says. “It works out really well that way.”

Doctors In The House

Although Madelia Community Hospital has four active staff physicians, its relationships with about 24 other specialists in the area allow the hospital to offer a far greater range of services to its patients.

Among the doctors considered to be “courtesy medical staff” at MCH are orthopedic surgeons, cardiologists and general surgeons. There’s a podiatrist, an ENT, an ophthalmologist and an OB surgeon. All either visit the hospital on a regular basis or come as needed for procedures.

Each one of them plays an important role in the hospital’s success. Outpatient care, especially the outpatient surgeries offered by many of the specialists, helps keep the hospital financially afloat.

“Outpatient surgery is one of the major reasons we’ve been able to remain fiscally sound,” Fenske says.

Saludando Salud

Madelia Community Hospital Administrator Candace Fenske says her hospital had some difficulty adjusting to the growing influx of Hispanic/Latino residents.

We have been involved with Region Nine’s “Saludando Salud” since 1996. Begun by a federal grant, Salud has trained bilingual interpreters in the usage of medical jargon. Working alongside Salud interpreters, Madelia Community Hospital has been allowed into a local meat packing plant to test all workers that wanted testing Latino or not for diabetes and cholesterol. The Latino community has a tendency toward diabetes.

In 1999, in addition, Madelia and St. James hospitals co-wrote a grant to receive a community health advisor, someone trusted by the Hispanic/Latino community, who was bilingual in writing and speech. That person’s job in part was to help people show up on time for appointments and follow up on patients taking their medication. When bilingual Dr. Gustavo Colmenares joined our staff in 2003, the hospital no longer seemed to have a need for this position.

When Dr. Colmenares isn’t on site, and if we need an interpreter to help a patient, we call interpreters in Madelia. If no one on that list is available, AT&T does offer an interpretive service over the telephone. But I can recall only one time that we have had to use it.

Before receiving help from Saludando Salud in 1996, we had a few awkward moments in the hospital. For interpreters often we used ones from Downs Foods or the high school. Even without an interpreter though, a patient’s body language can tell us a lot. Sometimes the patients have to use hand gestures before an interpreter arrives. You figure out different ways to communicate quickly.

More and more, the younger Hispanic/Latino people are bilingual. It was similar to when my ancestors moved to this country. Within a short period of time English became their primary language. We are seeing a gradual shift here as well to English being the primary language. – Candace Fenske.

© 2005 Connect Business Magazine. All Rights Reserved.

Daniel Vance

A former Editor of Connect Business Magazine

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